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Twins Need Time To Recuperate, Will Not Be Returning To Bhutan Anytime Soon: Dr Karma Sherab

“After the discharge, the Children’s First Foundation has decided to keep the family at the retreat centre where physiotherapy and all the facilities needed to catch up to a normal growth will be provided.”

(Source: Tech2.org)

By Tshering Delma | The Bhutanese

The first conjoined twins in Bhutan, Nima and Dawa Pelden will be kept at the Children’s First Foundation (CFF) retreat centre for a month after being successfully separated on 9 October at the Royal Children’s Hospital in Melbourne, Australia,.

The paediatric surgeon with the national referral hospital in Thimphu, Dr Karma Sherab said the twins need time to recuperate and will not be returning to Bhutan anytime soon.

He revealed that the muscles on their lower abdomens and lower limbs will take time to develop properly as they have never been used.

“After the discharge, the CFF has decided to keep the family at the retreat centre where physiotherapy and all the facilities needed to catch up to a normal growth will be provided.”

The Foundation will send them to Bhutan once the twins are ready. “It will take at least a month because they need to learn to physically function like normal children - to sit, walk or sleep,” he said.

“The twins are very much loved in Melbourne. They have been showered with all sorts of gifts toys, cards, letters and clothes,” he added.

Meanwhile, the girl’s father, 40-year-old Sonam Tshering is keeping in regular contact with his wife and daughters through video calls. Sonam said, “They were all smiles and seem to be doing well since the surgery.”

Background of the twins and their parents

Sonam Tshering is from Mongar and works as a messenger at the PHPA’s office in Phuentsholing while the mother, Bumchu Zangmo, 38, from Trashigang is a housewife. Nima and Dawa are the latest additions to the family, taking their total number of children to six.

Nima and Dawa were born on 14 July 2017 in Phuentsholing General Hospital by caesarean section. Their combined birth weight was 4.8 kilograms. The twins were immediately referred to the paediatric surgical unit, JDWNRH for further care and management.

Sonam Tshering said that it came as a shock when they first learned that the twins were conjoined. Since more than the challenges were needed to raise his conjoined babies, he was mostly worried about the future of the girls. “

We didn’t have any idea what to do and were really worried about how the girls will lead their lives,” he said.

However, he carried a hope that they would be separated in the future. “I can’t express how worried I was and how happy I am now that they are separated and will be leading individual lives,” he added,

“I shall remain always grateful to the doctors and to all the well-wishers for this miracle.”

Advice from Dr Karma Sherab and his role in organising the surgery in Australia

Dr Karma Sherab said that the parents were counselled on the situation early on, and informed that surgery was not immediately needed as it is always better to wait for at least 6 to 7 months than to do the separation surgery immediately and risk the lives of the twins.

“During the initial 6-7 months, we kept an eye on them while all medical check-ups were done to rule out any other associated life threatening anomalies,” Dr Karma Sherab said.

Dr Karma Sherub and mother Bumchu hold Nima and Dawa.

Source: Alex Coppel/Herald Sun

“Imaging was done to see what organs the twins shared and we were confident that they only shared the liver and maybe some bowel loops.”

After the study and discussions in the surgical department, it was agreed that the surgery could not be performed in Bhutan. The decision was made to perform the surgery in the best hospital by the best doctors.

“It was at this time that I contacted Dr Chris Kimber, Paediatric Surgeon at Monash Children’s Hospital in Melbourne who was my mentor during my one year fellowship training in Paediatric Urology.”

“The case details and all imaging studies were shared after which Dr Kimber agreed to go ahead with the surgery and asked the Children’s First Foundation to sponsor the whole process.”

Help given by the Children’s First Foundation

The Children’s First Foundation then contacted Dr Sherab. “They were very happy and eager to sponsor the separation surgery and then began a long process of paper works of getting consent from the parents, processing medical visas for the twins and the mother.”

The twins and their mother on the flight from Bhutan to Bangkok.

Source: Alex Coppel/Herald Sun

Dr Sherab was also in the operating room while the surgery was conducted on 9 October at the Royal Children’s Hospital, Melbourne. “

“Six senior surgeons, six senior anaesthesiologists were among the 25 or so of a team that conducted the surgery,” he said, adding that the twins shared one liver where the xiphisternum was joined too.

The liver was divided in the middle and put back in place. Plastic surgeons helped in the abdominal wall reconstruction.

“Dawa needed a prosthetic patch to cover her lower chest defect,” said Dr Sherab. Post operation, he said, the twins did really well and there were no immediate issues. The procedure took more than six hours.

The Children’s First Foundation sent two volunteers to escort the twins and mother to Melbourne on 2 October.

“With the consent from the health ministry, a nurse was deputed as a medical escort as the mother does not know how to speak English.”

Dr Karma Sherab said that the survival rate is 100 percent for the twins, the spine will gradually straighten and will be normal in the future.

Conjoined twins are very rare in occurrence. It happens when a single fertilised egg fails to split fully in the early embryonic stage.

The doctor also mentioned that the main challenge during the process was the mother’s health due to the intense situation of having to take care of the babies throughout, on top of the stress and worry over the surgery.